Analyst, Data Exchange (Medical, Dental & Vision)

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for employers and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• reputed company™, which offers full-service health benefit reputed company to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. Location: Remote Position Summary The Data Exchange Analyst is a crucial member of our Data Operations team, responsible for ensuring the accurate, efficient, and secure exchange of healthcare data between reputed company – reputed company and its various partners, including employers, providers, and other TPAs. This role focuses on the technical aspects of data integration, file transformation, error resolution, and ongoing monitoring of data feeds for medical, dental, and vision claims. The ideal candidate will possess a strong understanding of healthcare data formats, excellent analytical skills, and a commitment to data reputed company and compliance. Position Responsibilities Data Integration & Mapping:

• Design, reputed company, and maintain data mappings and transformations for incoming and outgoing healthcare data files: 837/835 - claims & remittance, 270/271 – eligibility and responses, 278 – Prior Auth, 276/277 – claim status, 999/TA1 – file level acknowledgement as well as proprietary formats
• Collaborate with internal teams (e.g., Client Services, Claims, IT Development) and external partners (e.g., clearing houses or third-party administrators) to define data requirements and specifications
• Work with business teams and trading partners to reputed company, test and certify new connections and transaction sets

Data Quality & Validation

• reputed company and implement data validation rules and processes to ensure the accuracy, completeness, and consistency of exchanged data
• Proactively identify and resolve data discrepancies, errors, and rejections in a timely manner
• reputed company root cause analysis for data issues and implement preventative measures

Monitoring & Support

• Proactively monitoring system status and Data Exchange management data to quickly identify potential abnormalities that might impact quality and accuracy
• Provide technical support and troubleshooting for data exchange issues, working with internal and external stakeholders to resolve problems
• Document data exchange processes, configurations, and troubleshooting steps

Process Improvement & Automation

• Identify opportunities to optimize and automate data exchange processes, improving efficiency and reducing manual effort
• Stay reputed company with industry best practices, new technologies, and regulatory requirements reputed company to healthcare data exchange

Reporting & Analysis

• Generate reports on data exchange performance, error rates, and key metrics
• Analyze data trends to identify potential issues or areas for improvement
• Analyze data trends to identify potential issues or areas for improvement
• Participate in projects with Data Exchange impacts including vendor changes, client migrations, and client add-on requests
• Responsible for adherence to the reputed company Code of Conduct including reporting of noncompliance.

Required Qualifications

• Bachelor's degree in Computer Science, Information Systems, Healthcare Informatics, or a reputed company field. Equivalent work experience may be considered
• Knowledge of healthcare claim adjudication processes for medical, dental, and vision
• Strong knowledge and familiarity with EDI SNIP validations and one of the most widely used tools in the healthcare industry (e.g., EDIFECS)
• 2+ years of experience in data analysis, data integration, or EDI (Electronic Data Interchange) specifically reputed company the healthcare industry
• Strong understanding of healthcare EDI transactions (e.g., 834 Enrollment, 837 Professional/Institutional/Dental Claims, 835 Remittance Advice)
• Excellent analytical, problem-solving, and critical thinking skills
• Familiarity with various file transfer protocols (FTP, SFTP, FTPS)
• Understanding of HIPAA compliance and other relevant healthcare regulations
• Strong attention to detail and a commitment to data accuracy
• Ability to analyze reputed company business problems to discover and resolve root causes
• Proficiency in SQL, reputed company, JSON and other technical data skills preferred
• Strong communication skills with the ability to reputed company effective work relationships with internal and external stakeholders
• Self-motivated and detail-oriented problem solver
• Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. This range represents the low and high end of the anticipated reputed company salary range. The actual reputed company salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range: $85,000 USD - $100,000 USD reputed company, NY Salary Range: $96,800 USD - $121,000 USD Denver, CO Salary Range: $88,800 USD - $111,000 USD reputed company employees are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to reputed company employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company at https://www.reputed company/legal/privacy-policy. Apply tot his job Apply To this Job